Healthcare Provider Details

I. General information

NPI: 1093759847
Provider Name (Legal Business Name): EMERGENCY PHYSICIAN SERVICES OF NEW YORK, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 09/22/2020
Certification Date: 09/22/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 NORTH RD
POUGHKEEPSIE NY
12601-1154
US

IV. Provider business mailing address

PO BOX 636008
CINCINNATI OH
45263-6008
US

V. Phone/Fax

Practice location:
  • Phone: 845-483-5000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: ROBIN MOUGANIS
Title or Position: DIRECTOR OF PE
Credential:
Phone: 856-686-4394